Increasing lead (Pb) screening participation rates in the pediatric patient population at the Philadelphia College of Osteopathic Medicine Lancaster Avenue Community Healthcare center

Philadelphia, PA

Elevated blood lead levels (EBLLs) are an ongoing public health crisis predominantly affecting children under six in low-income communities located in major cities across the United States. Chronic lead exposure due to outdated housing, polluted water, and contaminated soil is especially harmful in early childhood when a high rate of hand to mouth contact increases the risk of ingesting particulate matter containing lead (CDC). EBLLs can lead to neurocognitive deficits, cardiovascular disease, and epigenetic modifications to gene expression patterns. While precautionary measures and timely screening protocols greatly reduce the risk of developing severe disease, families within these communities continue to experience significant barriers to care. This includes patient hesitancy to perform conventional methods of blood lead level (BLL) screening through intravenous blood draw, inadequate access to less invasive screening procedures, and gaps in patient-provider communication. To address these barriers to care, less invasive screening procedures such as point-of-care capillary testing can be an effective alternative to traditional venous draws given its reported accuracy of 87% to 91% sensitivity. Additionally, coupling the procedure with consistent communication strategies to enhance the patient-provider relationship can further increase testing compliance. The Philadelphia College of Osteopathic Medicine Community Health Center located on Lancaster Avenue in the heart of Western Philadelphia serves a diverse pediatric population reflective of these risk factors and has similarly observed low screening participation rates without access to alternative screening methods. This prospective longitudinal cohort design study based on an electronic medical record review evaluates whether implementing point-of-care capillary BLL testing, combined with targeted patient-provider communication strategies, can improve BLL screening participation in comparison to conventional BLL screening methods. In doing so, the findings from this study may provide a replicable framework for clinics serving similar high-risk communities to improve pediatric BLL screening participation and reduce the disproportionate burden of lead exposure among children in underserved communities. Preliminary findings of this study have suggested that accessible point-of-care capillary testing combined with targeted patient-provider communication practices may enhance the overall BLL screening participation for eligible pediatric patients.